Health and Health Policy

Past Projects

Beyond Health Care: Community, Governance, and Culture in the Health and Wellness of Native Nations

2011-2015

Health is influenced not only by the health-care system but by broader aspects of community life—what often are called "social determinants of health." These factors operate outside the health-care system but can have profound impacts on basic health outcomes. Fresh foods, adequate sanitation, employment opportunities, and family stability are critical to the long-term health of communities.

NNI worked with a six Indigenous nations that vary on social, cultural, and political characteristics and in their level of community health; convened a forum and working meetings with tribal leaders, academics, and others; and conducted literature searches, dialogues with professionals, and other information gathering efforts. The project aimed to provide insight into a key question related to the social determinants of health: "What actions can Native communities takeoutside the health care systemto improve community health and wellness?"

What resulted are three distinct but related lines of inquiry:

  • 1.Reclaiming Indigenous Health
  • 2.Data Sovereignty and Data Governance for U.S. Indigneous Nations
  • 3.Opportunities in Tribal Public Health Policy

Summary: Beyond Health Care: Community, Governance, and Culture in the Health and Wellness of Native Nations, 9/2015 (pending)

Press Release: UA Native Nations Institute to Study Tribal Health Care, 6/2011

Supported by

W.K. Kellogg Foundation www.wkkf.org

Morris K. Udall and Stewart L. Udall Foundation www.udall.gov


Self-Determination and American Indian Health Care: The Shift to Tribal Control

2009-2010

With support from the W.K. Kellogg Foundation, NNI carried out a case-based study of what happens when Native nations take on a larger, more authoritative decision-making role in the management of health-care services on reservations. The work focused on the health-care system as generally conceived: a set of activities, positions, and persons (including therapies, preventive programs, clinics, hospitals, doctors, nurses, technicians, managers, other professionals, etc.) dedicated to improving health. Our goal was to understand the effect of an expanded role for tribes—as opposed to federal agencies—in the design, delivery, and governance of this system.

This research produced evidence that when American Indian nations take over a major decision-making role in health care, access to care on reservations improves. The process is not simple—tribal management of health care faces major challenges in areas such as funding, institution-building, governance, and so on. But there is reason to believe that tribal management can reduce health disparities between Indigenous populations and the mainstream U.S. population.

Paper:

Rainie, Stephanie Carroll, Miriam Jorgensen, Stephen Cornell, Jaime Arsenault. (2015).“The Changing Landscape of Health Care Provision to American Indian Nations.” American Indian Culture and Research Journal, 2015 9(1):1-23.

Poster: Self-Determination and American Indian Health Care: The Shift to Tribal Control,11/2012

Presentation: Self-Determination and American Indian Health Care: The Shift to Tribal Control, 9/2012

Supported by

W.K. Kellogg Foundation www.wkkf.org

Morris K. Udall and Stewart L. Udall Foundation www.udall.gov


A Preliminary Study of Tribal Control

2006-2008

Prior to the W.K. Kellogg-funded project outlined above, and with support from the Nathan Cummings Foundation and the Morris K. Udall and Stewart L. Udall Foundation, NNI carried out a preliminary analysis of tribal health-care initiatives and their impacts on American Indians’ and Alaska Natives’ access to health care. This analysis, including an extensive review of literature and interviews with eighteen Native health professionals from across the country, pointed to the importance of tribal control and helped shape the subsequent Kellogg Foundation-funded research.

Executive Summary: Improving Health Care Access in Native American Communities: What Can Tribes Do?, 9/2008

Op Ed: Arsenault and Rainie: Tribal management key to improved health services, 7/2009

Supported by

Nathan Cummings Foundation www.nathancummings.org

Morris K. Udall and Stewart L. Udall Foundation www.udall.gov

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